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IntroductionThe focused assessment with sonography for trauma (FAST) is a commonly used and life-saving tool in the initial assessment of trauma patients. The recommended emergency medicine (EM) curriculum includes ultrasound and studies show the additional utility of ultrasound training for medical students. EM clerkships vary and often do not contain formal ultrasound instruction. Time constraints for facilitating lectures and hands-on learning of ultrasound are challenging. Limitations on didactics call for development and inclusion of novel educational strategies, such as simulation. The objective of this study was to compare the test, survey, and performance of ultrasound between medical students trained on an ultrasound simulator versus those trained via traditional, hands-on patient format.MethodsThis was a prospective, blinded, controlled educational study focused on EM clerkship medical students. After all received a standardized lecture with pictorial demonstration of image acquisition, students were randomized into two groups: control group receiving traditional training method via practice on a human model and intervention group training via practice on an ultrasound simulator. Participants were tested and surveyed on indications and interpretation of FAST and training and confidence with image interpretation and acquisition before and after this educational activity. Evaluation of FAST skills was performed on a human model to emulate patient care and practical skills were scored via objective structured clinical examination (OSCE) with critical action checklist.ResultsThere was no significant difference between control group (N=54) and intervention group (N=39) on pretest scores, prior ultrasound training/education, or ultrasound comfort level in general or on FAST. All students (N=93) showed significant improvement from pre- to post-test scores and significant improvement in comfort level using ultrasound in general and on FAST (p<0.001). There was no significant difference between groups on OSCE scores of FAST on a live model. Overall, no differences were demonstrated between groups trained on human models versus simulator.DiscussionThere was no difference between groups in knowledge based ultrasound test scores, survey of comfort levels with ultrasound, and students’ abilities to perform and interpret FAST on human models.ConclusionThese findings suggest that an ultrasound simulator is a suitable alternative method for ultrasound education. Additional uses of ultrasound simulation should be explored in the future.

SummaryAn investigation of noise levels in a hospital ward, a cubicle off the ward, and an intensive therapy unit (ITU) showed that the noise levels in all three areas were higher than internationally recommended levels at all times of day. Loud noises above 70 dB(A) were common in all areas but especially the ITU. The noise pollution levels reached annoying values during the day in the ward and cubicle and during both the day and the night in the ITU. Equipment and conversations among the staff were the main causes of noise in the ITU.These noisy environments are unlikely to help patients recover. Although measures designed to eliminate noisy surfaces will help, making staff aware of the noise they create and the effects it has may be much more effective in reducing noise pollution.

Objectives: There is currently no consolidated list of existing simulation fellowship programs in emergency medicine (EM). In addition, there are no universally accepted or expected standards for core curricular content. The objective of this project is to develop consensus-based core content for EM simulation fellowships to help frame the critical components of such training programs.Methods: This paper delineates the process used to develop consensus curriculum content for EM simulation fellowships. EM simulation fellowship curricula were collected. Curricular content was reviewed and compiled by simulation experts and validated utilizing survey methodology, and consensus was obtained using a modified Delphi methodology.Results: Fifteen EM simulation fellowship curricula were obtained and analyzed. Two rounds of a modified Delphi survey were conducted. The final proposed core curriculum content contains 47 elements in nine domains with 14 optional elements. Conclusion:The proposed consensus content will provide current and future fellowships a foundation on which to build their own specific and detailed fellowship curricula. Such standardization will ultimately increase the transparency of training programs for future trainees and potential employers.

Midwives in Liberia had very low baseline knowledge and comfort using ultrasound. A 1-week curriculum increased both short- and long-term knowledge and comfort and led to adequate overall OSCE scores that were retained at 1 year.

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Emergency Department (ED) physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Solutions include professional interpretation, telephone interpretation, the use of bilingual staff members, the use of ad hoc interpreters, and more recently the use of mobile computer technology at the bedside. Each method carries a specific set of advantages and disadvantages. Although professionally-trained medical interpreters offer improved communication, better patient care, and overall cost savings, they are underutilized due to their perceived inefficiency. Ultimately, the solution will vary for every Emergency Department (ED) depending on the population served and available resources. Accessibility of the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally competent provider/health systems and overall improved patient care.

Prior studies on proning awake, non‐intubated patients with hypoxemic acute respiratory failure, as well as evolving study of similar COVID‐19 patients, coupled with experience and dramatic anecdotal evidence from the COVID‐19 pandemic, suggest the importance of proning all such patients with COVID‐19 to improve oxygenation and reduce respiratory effort. Literature and experience from healthcare teams in the midst of the pandemic suggest that any COVID‐19 patients with respiratory compromise severe enough to warrant admission should be considered for proning. We additionally suggest these patients should be considered for proning as well as ongoing patient re‐positioning (e.g. right lateral decubitus, seated, and left lateral decubitus positions). Figure 1 represents the proning and positioning instructions developed at New York City Health + Hospitals/Elmhurst, a large, inner‐city, tertiary public hospital in the epicenter of the COVID‐19 pandemic in New York City, and later adapted and utilized at facilities across the United States.